Tag Archives: patient-as-customer

Should Doctors Limit Medical Care To Save Money For ‘Society’?

Paul Hsieh, MD writes:

There will always be limits on who will or will not receive expensive medical treatments. We have no choice about that. But we do have a choice of whether those decisions will be made by patients based on their personal and economic priorities — or by government bureaucrats. The first protects the doctor-patient relationship. The second creates divided loyalties for doctors, who will always be serving two masters. As a doctor, I prefer the first. As a patient, you should too.

Read more: Should Doctors Limit Medical Care To Save Money For ‘Society’?.

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Filed under insurance, tax code, HSAs, Medicaid/Medicare/SCHIP, physicians & medical quality

Oklahoma Doctors vs. Obamacare – Reason.com

From Reason:

The major cause of exploding U.S. heath care costs is the third-party payer system, a text-book concept in which A buys goods or services from B that are paid for by C. Because private insurance companies or the government generally pick up most of the tab for medical services, patients don’t have the normal incentive to seek out value.The Surgery Center’s consumer-driven model could become increasingly common as Americans look for alternatives to the traditional health care market—an unintended consequence of Obamacare. Patients may have no choice but to look outside the traditional health care industry in the face of higher costs and reduced access to doctors and hospitals.

Read more: Oklahoma Doctors vs. Obamacare – Reason.com.

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Filed under physicians & medical quality

Government violates your medical privacy for medical price comparisons. But private sector already does this.

On November 1, Denver Business Journal reported:

The Center for Improving Value in Health Care (CIVHC) launched a website Thursday that officials believe eventually will give Colorado patients and insurers a tangible way to find health care that is less expensive and more effective, bringing down its overall costs.

By the end of 2013, the All Payers Claims Database (link here) is expected to be able compare the costs of major medical procedures at hospitals and outpatient centers across the state, allowing allow people to choose less costly care and pressure expensive outliers to bring down prices.

Amy Oliver and Linda Gorman have reminded us that the All-Payer Claims Database threatens our medical privacy:

As if this isn’t bad enough, the alleged benefit of government taking our medical data for a website that compares prices is dubious. The private sector is already doing this. For example:

There’s more. In an article titled “How to Research Health Care Prices,” the Wall Street Journal states:

Changehealthcare.com, a unit of change:healthcare Inc., provides estimates of how much individual providers are paid by insurers, based on claims data from health plans.

And NewChoiceHealth.com gives providers’ list prices, which are derived from Medicare data, according to New Choice Health Inc. Another site, OutOfPocket.com, has a search service to help users find online pricing information listed on various sites.

You can also check for prices posted by specific hospitals and doctors. These are still relatively rare, and may represent list charges. But a few hospitals are also revealing roughly what they’re paid by insurers or offering calculators so insured patients can figure their out-of-pocket fees. A site called PriceDoc.com seeks to aggregate listings from doctors.

But government has the ability to create an unfair competitive advantage by requiring physicians to divulge information. Hmm.

See also John C. Goodman’s post: Domestic Medical Tourism is Taking Off.

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Filed under Colorado health care

What reach your doctor 24/7? Pay her directly at a new Denver care center

Economist John Goodman explains why you typically cannot reach your doctor on the phone or over the Internet: Medicare and insurers don’t pay them for this. This changes when you pay your doctor directly. The Denver Business Journal reports on a new direct-pay medical office where doctors are available at all times:

Dialysis center giant DaVita Inc. has opened its first primary-care center in Colorado, offering concierge medicine to both employees and outsiders in what it says is an effort to improve health and reduce costs by competing with traditional physicians’ practices.

Paladina Health LLC, a clinic that opened on Sept. 3 at 1783 15th St., offers two physicians and two medical assistants to treat individuals or employers who pay a monthly fee. …

Under the concierge medicine concept practiced there, patients will pay a monthly fee — $99 for adults, $59 for children and various negotiated prices for companies — and receive unlimited services from doctors rather than paying per visit, Steinfort said.

By allowing doctors to spend more time with patients, and be available to them via cellphone and web portal at all times, DaVita believes it can drive improvements to customer service and to health while cutting the cost of care if patients don’t wait until they are severely ill to see a doctor, Steinfort said.

via DaVita opens Denver health care office.

At the Center for Individual Freedom, Ashton Ellis gives more background on direct-pay medicine:

Tom Blue, Executive Director of the American Academy of Private Physicians, says that doctors are seeing revenue drop precipitously as the costs of regulations, drugs and medical liability skyrocket, while reimbursements from public and private insurance providers plunge.

In response, Blue says that a growing number of doctors are converting their practices to a new business model that cuts out the middle men, and enhances the doctor-patient relationship.

Direct-pay medical contracts require a one-time annual fee that buys 24/7 access to a primary care physician, same day appointments and a doctor-patient relationship reminiscent of an era before third party insurers and government subsidies.

More: Direct-Pay Medicine: A Free Market Approach to Healthcare Reform



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Newborns & children drive Colorado Medicaid costs. A solution? Make Medicaid parents pay more.

The Independence Institute’s Linda Gorman writes:

Health policy discussions often focus on controlling the cost of the sophisticated medical care that is provided to relatively few people. Outside of this blog, relatively few people pay attention to the impact of routine costs like the cost of an extra physician visit for each of 150 million people. This is one reason why so many people are surprised by the fact that consumer directed health plans with proper incentive structures can lower health care expenditures by as much as 20 percent without compromising health or externally rationing care. It also explains why so many Medicare commentators have difficulty understanding how the Ryan Medicare reform plan might work.

Below is a list of what officials at Colorado Medicaid consider the top 10 “cost drivers” for the state Medicaid program as shown in one of the Colorado’s budget documents. Six of the ten cost drivers revolve around labor and delivery and routine physician visits by children.  …

The performance goals given by the state Medicaid bureaucracy grandly propose containing these costs. In response, state budget staff have asked, quite sensibly, whether the Department plans to “reduce vaginal deliveries without complicating diagnoses” by reducing the number of births?

Read more: Colorado’s Medicaid Cost Drivers | John Goodmans Health Policy Blog | NCPA.org.

Here’s a simple answer to reducing the number of births: Make Medicaid recipients pay some of their own money for delivering their babies.  Adults have a right to procreate, but we don’t have a right to do so at the expense of other people, e.g., taxpayers who fund Medicaid.

Check out Colorado Medicaid co-payments. For in-patient services, it’s just $10 per day! As I’ve documented before, the poorest households can afford to pay much more than that.


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Filed under Colorado health care

US Health Care Spending Since 1960: Patients pay less, insurers & gov’t pay more

The California Healthcare Foundation has an informative interactive graphic:

In 1960, almost 100% of the spending on prescription drugs came out of the consumers pocket; by 2010, out-of-pocket spending was down to 20%. Over the past 50 years, there have been major shifts in the way hospital care, physician services, long-term care, prescription drugs, and other services and products are paid for. This interactive graphic uses data from the Centers for Medicare and Medicaid Services to show national spending trends from 1960 to 2010 for health care by payer.

See the graphic here: US Health Care Spending: Who Pays?.

For an explanation of why extreme third-party payment is bad, read “Insulation vs. Insurance” by Arnold Kling.

via FIRM

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Filed under Policy - National

John C. Goodman on his new book, Priceless

Originally aired June 21, 2012. Independent Institute Research Fellow Dr. John C. Goodman, author of “Priceless: Curing the Healthcare Crisis,” joins a panel on Stossel to speak on healthcare issues.

Note that the doctor in favor of ObamaCare starts from the false premise that health care is a “right.

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